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Prospective Cohort Study of Fatal Lung Cancer, Inflammation, Smoking and Lifestyle Risk Factors: Results from the Third National Health and Nutrition Examination Survey

Bittoni, Marisa Anna
http://rave.ohiolink.edu/etdc/view?acc_num=osu1374074945

Abstract Details

2013, Doctor of Philosophy, Ohio State University, EDU Physical Activity and Educational Services.
Background: C-reactive protein (CRP), a biomarker of inflammation, is an acute-phase protein that displays a rapid and distinct rise in plasma concentration in response to acute inflammation, infection and tissue damage. CRP levels have been found to be moderately elevated in individuals with lung cancer. Few studies have examined associations between lung cancer, CRP, and other inflammatory factors, and these studies have not shown consistent results. The primary goals of this study were to: 1) prospectively examine the overall association between CRP and fatal lung cancer; 2) examine the effect of modifiable lifestyle factors, such as diet and physical activity on this relationship; and 3) examine the effects of demographic and other lifestyle risk factors, such as age, gender, race, smoking and obesity on inflammation and fatal lung cancer. Secondary goals were to examine the effect of demographic and lifestyle factors on CRP. Methods: Data from cancer-free individuals over age 40 in the Third National Health and Nutrition Examination Survey (NHANESIII:1988-1994) were examined prospectively in relation to inflammatory factors and fatal lung cancer. Mortality status was ascertained through probabilistic record matching using the National Death Index, with mortality follow-up through 2006. Baseline demographic and clinical data were acquired from interviews and laboratory examinations. Cox proportional hazards regression assessed factors related to inflammation and fatal lung cancer. Logistic regression assessed the effect of lifestyle factors on CRP. Results: Of 8,950 participants, 219 individuals died of lung cancer during the 218-month follow-up period. Individuals who died from lung cancer were significantly more likely to be male (66% vs 48%), older (65 vs 61 years), to have elevated serum CRP levels (>3mg/L; 51% vs 39%), lower mean BMI (26 vs 28 kg/m2), and to ever have smoked >100 cigarettes (92% vs 54%). Multivariate regression models revealed a dose-response effect for CRP and fatal lung cancer risk (p-trend<0.0001) when adjusting for age, gender, BMI and ever having smoked. Hazards ratios (HR) were significantly increased for CRP levels of 3-7 mg/L (HR=1.63, P<0.01) and >7 mg/L (HR=2.44, P<0.01) compared to CRP levels in the normal range (<3 mg/L). Models stratified on age and gender revealed significant associations between CRP and fatal lung cancer for males and smokers, but estimates did not reach statistical significance for females and non-smokers. The lung cancer risk for smokers was 9 times that of non-smokers when adjusting for other factors (p<0.0001). Higher BMI was protective, especially for males and smokers. Walking and higher Healthy Eating Index scores were also significantly related to reduced fatal lung cancer and inflammation, but again the effects were more pronounced among males and smokers. Conclusions: The results of this study showed a dose-response effect for CRP and fatal lung cancer, which was more pronounced in males and smokers. Higher BMI, walking and higher Healthy Eating Index scores emerged as protective factors, but primarily for males and smokers. Future studies should explore reasons for the different results among females and non-smokers, such as environmental, histologic, or genetic factors that may account for differences in the results.
Brian Focht, PhD (Advisor)
Randall Harris, MD, PhD (Committee Member)
Steven Clinton, MD, PhD (Committee Member)
Janet Buckworth, PhD (Committee Member)
198 p.
Epidemiology; Health Sciences; Nutrition; Public Health
Inflammation; lung cancer; c-reactive protein; smoking; diet; obesity; physical activity

Recommended Citations

Citations

  • Bittoni, M. A. (2013). Prospective Cohort Study of Fatal Lung Cancer, Inflammation, Smoking and Lifestyle Risk Factors: Results from the Third National Health and Nutrition Examination Survey [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1374074945

    APA Style (7th edition)

  • Bittoni, Marisa. Prospective Cohort Study of Fatal Lung Cancer, Inflammation, Smoking and Lifestyle Risk Factors: Results from the Third National Health and Nutrition Examination Survey. 2013. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1374074945.

    MLA Style (8th edition)

  • Bittoni, Marisa. "Prospective Cohort Study of Fatal Lung Cancer, Inflammation, Smoking and Lifestyle Risk Factors: Results from the Third National Health and Nutrition Examination Survey." Doctoral dissertation, Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1374074945

    Chicago Manual of Style (17th edition)

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This open access ETD is published by The Ohio State University and OhioLINK.